Dissertations / Theses on the topic 'Access to health care'
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1
Blanton, Sandra. "Justice in Health Care Access Measuring Attitudes of Health Care Professionals." TopSCHOLAR®, 2000. http://digitalcommons.wku.edu/theses/714.
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To measure attitudes toward justice in access to health care services in managed care plans in a convenience sample of medical professionals at Clark Memorial Hospital in Jeffersonville, Indiana. Methods. A sixteen item, self-administered instrument based on Morreim's four concepts of justice in health care access was administered to 147 health care professionals, representing physicians, allied health, and hospital administration. SPSS was used to analyze the results. Results. The attitudes of the respondents were negative toward managed care. They did not feel that managed care had been a positive development in the United States or that managed care had improved access to preventive care or improved primary care. On the survey instrument, respondents scored highest on the scale measuring fairness to individual patients. Conclusion. In a convenience sample of health care professionals at Clark Memorial Hospital in Jeffersonville, Indiana, equity in distributing access to health care among individual patient needs was found to more closely meet their expectations of justice in health care access. There were no differences found across occupational groups in their responses to the two scales. There were differences in attitudes toward managed care among occupational groups.
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Fike, Verinda Jean Esther. "Health insurance and health care access in China." CONNECT TO ELECTRONIC THESIS, 2008. http://dspace.wrlc.org/handle/1961/5527.
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Marshall, Emily Gard. "Universal health care? : access to primary care and missed health care of young adult Canadians." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/30948.
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Prevalence of missed health care by life course stage is examined with a critique of the
measure of missed care. Canadians reporting missed care has increased from 4.2% in
1995 to 12.5% in 2001. Research questions: 1. Who reports missed care in Canada? 2.
What are the relationships among life course stages, social support, predisposing,
enabling and need factors to the reporting of missed care? 3. What is the role that life
course stages play in the relationships among social support, predisposing, enabling, and
need factors? 4. What kinds of health care are Canadians reporting they missed? 5. What
reasons are provide for missing care?; and 6. Who accesses primary care and what is the
relationship to reporting missed care? Methods: Analysis was done using the Canadian
Community Health Survey Cycle 2.1. Nested multiple logistic regression models explore
the relationships among variables of interest predicting missed care. Results: Young
adults (18-30) are more likely to report missed care compared to other age groups and
are least likely to have a regular doctor. Social support is most significantly protective
against missed care for young adults. Weak sense of belonging to a local community
and lower income are stronger predictors of missed care for young adults. Young adults
differ from others in the reasons they report for missed care (i.e., more likely to report
cost as a barrier). Discussion: It's not clear if the difference between young adults and
other life course stages is in actual missed care or expectations of primary care. Yet, the
literature on emerging adulthood invites curiosity about how delayed adulthood leaves
them in less stable, financially insecure, socially and institutionally isolated situations
that have subsequent consequences for primary care access. Changes in models of
primary care have led to a decline in comprehensive care and more drop-in clinics; while,
not having a regular doctor is associated with missed care. If patterns of inadequate
primary care access established in young adulthood are perpetuated in later life, this may
foretell undesirable consequences for the health of Canadians. A new model for
measuring unmet health care needs is proposed.Graduate and Postdoctoral Studies
Graduate
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Smith, Raymond Joshua. "Frontier residents' perceptions of health care access." Thesis, Montana State University, 2008. http://etd.lib.montana.edu/etd/2008/smith/SmithR0508.pdf.
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It can be difficult to access health care due to cost, lack of insurance, and lack of available resources for Americans today. Frontier persons have even more obstacles in accessing health care due to geography, time and distance to facilities, lack of medical personal, and culture. This study's purpose was to better understand frontier residents' perceptions of access to health care. Specific aims were to (a) explore frontier residents' health care access resources, (b) investigate frontier residents' utilization of health care services, (c) search for reasons frontier residents seek health care (d) and explore the residents' overall satisfaction regarding their health care access options. A qualitative approach that included open-ended questions was used to interview a convenience sample of 11 frontier residents in a Southwestern Montana town. Participants were recruited using a snowball approach. Common themes were extracted using a "low inference" analysis style. Aday and Andersen's framework and their study of access to medical care (1975) guided the study. Results revealed most residents felt they had access to health care and all had seen a provider in the last 2 years. Residents used "local" services, the closest being 70 miles away, for minor ailments and injuries or when home remedies failed. A "by-pass" mentality of "local" services was seen for more serious events. Children were treated differently and health care was sought sooner if they became ill. Reasons for seeking care included preventative services, acute injuries, and infectious processes. Cost, weather, road conditions, gas prices, travel time, and taking time off work were mentioned as barriers in health care utilization. Insurance deductibles and costs of health services limited the type of health care residents sought. Satisfactions with health care providers were high as well as sliding scale fees of the local health centers. Cost and distance were unsatisfactory. Implications for practice include educating residents about benefits and abilities of their local resources, the need to seek care for preventative services, health promotion topics, and disease prevention. In addition, health care authorities should focus on alternative ways to bring health care to the frontier residents including telemedicine and lowering costs.
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Kama, Zukiswa Shirley. "An evaluation of access to health care : Gugulethu Community Health Clinic." Thesis, Cape Peninsula University of Technology, 2017. http://hdl.handle.net/20.500.11838/2456.
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Thesis (MTech (Public Management))--Cape Peninsula University of Technology, 2017.The purpose of this study was to examine the problem of access to health care centres in the Western Cape and to forward recommendations that will improve access to health care facilities in the Western Cape. The first objective of the study was to identify trends in primary health care looking at Nigeria, with the view of learning lessons of experience. Secondly, the study provided an overview of the South African health care system. The study further examined the problems around access to Gugulethu Community Health Clinic. The research objectives were directly linked to the composition of chapters. The study utilised a mixed-method approach of quantitative and qualitative approaches. This method is called multi-method approach. The purpose of combining the two approaches was to understand the research problem from a subjective and objective point of view, as well as to provide an in-depth understanding of a research topic, which led to more reliable research results. Data collection was acquired by utilising a structured questionnaire and personal observations. Two groups of respondents participated in the study inter alia: the patients and the staff of Gugulethu Community Health Clinic.
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Vedom, Julia. "Health care access and regional disparities in China." Thesis, University of Ottawa (Canada), 2008. http://hdl.handle.net/10393/25483.
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This thesis examines the access of health care facilities in nine provinces of China between the years 1989 and 2004, evaluating the effect of demographic, financial and geographic factors. Equity in social welfare has long played a major role in shaping China's national policies. However, continued pursuit of the GDP-led development orientation in China since the late 1970s has resulted in increasing urban-rural and intra- and inter-regional socio-economic disparities, raising multiple causes for concern from an equity perspective and suggesting the trends that should be closely monitored. While there is a consensus about the need and importance of access equity, little geographic research has been conducted in this area.
In light of these issues, using China Health and Nutrition Survey this study addressed the following two objectives: (1) to describe the geographic and financial disparities in access to clinics and hospitals in nine provinces of China during the 1989-2004 period, and (2) to explore the demographic, socio-economic and geographic factors affecting access to health care.
Results of the analysis show that between 1989 and 2004 the accessibility gap between hospitals and clinics in terms of geographic indicators has decreased, while the gap in financial accessibility has increased, making urban hospitals the least accessible facilities. Access to both hospitals and clinics in urban and rural areas is mostly conditioned by geographic factors, namely the travel method, region of residence and the availability of health care facilities. Patients who were able to reach the facilities on foot were more likely to enjoy better access than those who were not able to do so. Similarly, residents of western China (Guangxi and Guizhou) along with the provinces with higher availability of health care facilities also tended to have better potential access than their counterparts.
Several important contributions essential for informing public decision- and policymaking stem from this thesis, leading to a better understanding of issues related to the accessibility of health care in nine provinces of China. While, typically, the determinants of accessibility have been attributed to the financial or demographic characteristics of patients, this research has identified geographic factors as being of the foremost importance in the accessibility of health care. This important finding provides grounds for further geographic research on accessibility issues in China. While our conceptual framework was designed for studying the accessibility of health care in China, it can be potentially applied to any country with regional, provincial or neighborhood disparities in access.
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Morrisey, Karyn Marie. "Access to health care services in rural ireland." Thesis, University of Leeds, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.502767.
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Castro, Beatriz. "Access control regulation in the health care sector." Thesis, Stockholms universitet, Juridiska institutionen, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-156879.
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This thesis is about access control in the health care sector. Access control is a function in It-systems that allows authorized users to access data they have right to access, prevents unauthorized users from accessing data and prevents authorized users from disclosing data unlawfully. One of the pillars of access control is that a user only is authorized to access data that he or she needs to perform a task. This describes the principle of least privilege and its objective is to ensure data's confidentiality and integrity. In the health care sector where an increasing number of public and private actors are processing sensitive data the application of this principle is essential to protect patients' privacy and confidence in the system. The lawmaker has incorporated the principle of least privilege in legal bodies such as the General Data Protection Regulation, Patient Data Act and the regulation of registers that allow processing of health data. This thesis examines how the lawmaker has incorporated the principle of least privilege to protect health data. Therefore, it examines access control regulation, in particular, requirements on management of access rights and log audits. The lawmaker has applied this principle through requirements on the system that should be incorporated by default and through requirements on management of access rights. The conclusion is that given that the tendency in health care, like in other sectors, is toward automation and more focus on self-care, the requirements should be directed more to systems than medical staff.
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Abbasgholizadeh, Rahimi Samira. "Prioritization of patients' access to health care services." Doctoral thesis, Université Laval, 2017. http://hdl.handle.net/20.500.11794/27499.
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L'accès aux services de santé et les longs délais d'attente sont l’un des principaux problèmes dans la plupart des pays du monde, dont le Canada et les États-Unis. Les organismes de soins de santé ne peuvent pas augmenter leurs ressources limitées, ni traiter tous les patients simultanément. C'est pourquoi une attention particulière doit être portée à la priorisation d'accès des patients aux services, afin d’optimiser l’utilisation de ces ressources limitées et d’assurer la sécurité des patients. En fait, la priorisation des patients est une pratique essentielle, mais oubliée dans les systèmes de soins de santé à l'échelle internationale. Les principales problématiques que l’on retrouve dans la priorisation des patients sont: la prise en considération de plusieurs critères conflictuels, les données incomplètes et imprécises, les risques associés qui peuvent menacer la vie des patients durant leur mise sur les listes d'attente, les incertitudes présentes dans les décisions des cliniciens et patients, impliquant l'opinion des groupes de décideurs, et le comportement dynamique du système. La priorisation inappropriée des patients en attente de traitement a une incidence directe sur l’inefficacité des prestations de soins de santé, la qualité des soins, et surtout sur la sécurité des patients et leur satisfaction. Inspirés par ces faits, dans cette thèse, nous proposons de nouveaux cadres hybrides pour prioriser les patients en abordant un certain nombre de principales lacunes aux méthodes proposées et utilisées dans la littérature et dans la pratique. Plus précisément, nous considérons tout d'abord la prise de décision collective incluant les multiples critères de priorité, le degré d'importance de chacun de ces critères et de leurs interdépendances dans la procédure d'établissement des priorités pour la priorisation des patients. Puis, nous travaillons sur l'implication des risques associés et des incertitudes présentes dans la procédure de priorisation, dans le but d'améliorer la sécurité des patients. Enfin, nous présentons un cadre global en se concentrant sur tous les aspects mentionnés précédemment, ainsi que l'implication des patients dans la priorisation, et la considération des aspects dynamiques du système dans la priorisation. À travers l'application du cadre global proposé dans le service de chirurgie orthopédique à l'hôpital universitaire de Shohada, et dans un programme clinique de communication augmentative et alternative appelé PACEC à l'Institut de réadaptation en déficience physique de Québec (IRDPQ), nous montrons l'efficacité de nos approches en les comparant avec celles actuellement utilisées. Les résultats prouvent que ce cadre peut être adopté facilement et efficacement dans différents organismes de santé. Notamment, les cliniciens qui ont participé à l'étude ont conclu que le cadre produit une priorisation précise et fiable qui est plus efficace que la méthode de priorisation actuellement utilisée. En résumé, les résultats de cette thèse pourraient être bénéfiques pour les professionnels de la santé afin de les aider à: i) évaluer la priorité des patients plus facilement et précisément, ii) déterminer les politiques et les lignes directrices pour la priorisation et planification des patients, iii) gérer les listes d'attente plus adéquatement, vi) diminuer le temps nécessaire pour la priorisation des patients, v) accroître l'équité et la justice entre les patients, vi) diminuer les risques associés à l’attente sur les listes pour les patients, vii) envisager l'opinion de groupe de décideurs dans la procédure de priorisation pour éviter les biais possibles dans la prise de décision, viii) impliquer les patients et leurs familles dans la procédure de priorisation, ix) gérer les incertitudes présentes dans la procédure de prise de décision, et finalement x) améliorer la qualité des soins.Access to health care services and long waiting times are one of the main issues in most of the countries including Canada and the United States. Health care organizations cannot increase their limited resources nor treat all patients simultaneously. Then, patients’ access to these services should be prioritized in a way that best uses the scarce resources, and to ensure patients’ safety. In fact, patients’ prioritization is an essential but forgotten practice in health care systems internationally. Some challenging aspects in patients’ prioritization problem are: considering multiple conflicting criteria, incomplete and imprecise data, associated risks that threaten patients on waiting lists, uncertainties in clinicians’ decisions, involving a group of decision makers’ opinions, and health system’s dynamic behavior. Inappropriate prioritization of patients waiting for treatment, affects directly on inefficiencies in health care delivery, quality of care, and most importantly on patients’ safety and their satisfaction. Inspired by these facts, in this thesis, we propose novel hybrid frameworks to prioritize patients by addressing a number of main shortcomings of current prioritization methods in the literature and in practice. Specifically, we first consider group decision-making, multiple prioritization criteria, these criteria’s importance weights and their interdependencies in the patients’ prioritization procedure. Then, we work on involving associated risks that threaten patients on waiting lists and handling existing uncertainties in the prioritization procedure with the aim of improving patients’ safety. Finally, we introduce a comprehensive framework focusing on all previously mentioned aspects plus involving patients in the prioritization, and considering dynamic aspects of the system in the patients’ prioritization. Through the application of the proposed comprehensive framework in the orthopedic surgery ward at Shohada University Hospital, and in an augmentative and alternative communication (AAC) clinical program called PACEC at the Institute for Disability Rehabilitation in Physics of Québec (IRDPQ), we show the effectiveness of our approaches comparing the currently used ones. The implementation results prove that this framework could be adopted easily and effectively in different health care organizations. Notably, clinicians that participated in the study concluded that the framework produces a precise and reliable prioritization that is more effective than the currently in use prioritization methods. In brief, the results of this thesis could be beneficial for health care professionals to: i) evaluate patients’ priority more accurately and easily, ii) determine policies and guidelines for patients’ prioritization and scheduling, iii) manage waiting lists properly, vi) decrease the time required for patients’ prioritization, v) increase equity and justice among patients, vi) diminish risks that could threaten patients during waiting time, vii) consider all of the decision makers’ opinions in the prioritization procedure to prevent possible biases in the decision-making procedure, viii) involve patients and their families in the prioritization procedure, ix) handle available uncertainties in the decision-making procedure, and x) increase quality of care.
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Norton, Lavinia Jane. "Individual responsibility, justice and access to health care." Thesis, University of Leeds, 2001. http://etheses.whiterose.ac.uk/977/.
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The aim of this thesis is to examine whether it is morally defensible to use lifestyle as one of the criteria for rationing health care. I argue that it is not justifiable to use former lifestyle to select patients for treatment. Chapter one outlines the principles of the NHS and discusses the reality of rationing in health care provision in Britain. I maintain that there is a prima facie legal and moral right to health care and explore whether this right imposes a responsibility on individuals to maintain a healthy lifestyle. Chapter two critically examines some of the criteria, which are used to ration health care. Government policy documents, such as 'The New NHS: Modern.Dependable.' (Department of Health 1997: 13) suggest that patients should be treated 'according to need and need alone.' I argue that the concept of medical need is indeed one of the proper criteria for the distribution of medical resources. However, it is not the only relevant criterion and should be considered along with other factors such as patient choice, clinical and cost effectiveness. Other criteria including age and lifestyle may also be relevant, but in so far as they affect the probable clinical outcomes of treatment. Chapter three clarifies some of the contemporary approaches to distributive justice and explores their implications for the allocation of health care between individuals. I suggest that an eclectic approach should be adopted where consideration is given both to promoting individual choices about lifestyles and protecting the welfare of the community. None of these theories of justice suggest that taking lifestyle into account when allocating scarce resources must be unjust. Chapter four investigates whether individuals should be held responsible for their lifestyle. I argue that some health related behaviour is voluntary and therefore people might be held responsible for the consequences of their behaviour. However, in many cases health related behaviour may not be voluntary, because it may have been unduly influenced by factors beyond the control of the individual. Even if it is voluntary, it may be justifiable or excusable in some cases. I discuss whether risk takers deserve any blame, and maintain that withdrawal or delay of medical treatment as a punishment for former lifestyle is always wrong. Chapter five argues that it is essential for health care professionals to inform people of risks to their health. This does not interfere with their liberty, and allows them to make choices based upon their own values. I also examine whether it is justifiable to use more coercive strategies, such as persuasion, manipulation and legal prohibition in order to encourage people to maintain a healthy lifestyle. Chapter six argues that it is not possible to implement a policy to ration health care partly on the basis of lifestyle in a fair way. I propose an alternative policy, which involves taxation on certain products associated with risk. Chapter seven examines a variety of cases of rationing based on lifestyle. I conclude that rationing according to former lifestyle is not morally defensible.
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Sun, Xiao Ming. "Health access and health financing in rural China." Thesis, Keele University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263121.
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Nearon, Darrell Maxwell Jr. "A study of the relationship between health care access and access barriers to behavioral health care for African Americans utilizing the managed care model." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2001. http://digitalcommons.auctr.edu/dissertations/AAI3034591.
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Managed care has revolutionized the healthcare industry. Prior to managed care, traditional insurance companies managed the healthcare industry. These insurance firms would monitor and authorize treatment to persons enrolled with the insurance company. Health Maintenance Organizations (HMOs) began to develop methods to provide similar service as the large insurance companies at a fraction of the cost. HMOs accomplished this by selling their products directly to employer groups. This significantly reduced administrative costs that had been traditionally passed on to the consumer. Unable to financially keep pace with the HMOs, the insurance companies abandoned the health insurance arena. As managed care has grown so have the problems associated with his system. Issues involving antitrust, confidentiality, privacy, and best practices are but a few of the critical issues facing managed care. All three branches of the United States government have been involved in resolving issues pertaining to managed care. Reforms have been demanded from the system and the current political climate may force the system to reconsider the manner in which it is conducting business. Minority consumers and specifically African Americans traditionally have been discriminated against from engaging in such life activities as housing, voting, commerce, and banking, without judicial intervention. The healthcare industry is no exception. The United States Surgeon General, in his seminal report on mental health, identifies that African Americans and other minorities have been excluded from obtaining appropriate and timely healthcare. The Surgeon General's report coupled with the President's report on Healthy People 2000, identify that initiatives are needed to rectify the inequities in healthcare in healthcare service delivery. A total of fifty-two African American consumers of mental health service with a primary diagnosis of adjustment disorder were surveyed to assess their perceptions as to whether or not they have access to their behavioral health services. The Consumer Access Questionnaire was designed to gather both demographic and consumer perceptions on the accessibility and feasibility of managed care for this selected population of African Americans. In all categories surveyed on the questionnaire, the results revealed that the respondents were able to access their outpatient behavioral health provider when utilizing the managed care system. The respondents provided an overall satisfaction rate with their respective managed care plans.
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Nearon, Darrell M. "A study of the relationship between health care access and access barriers to behavioral health care for African Americans utilizing the managed care model." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2001. http://digitalcommons.auctr.edu/dissertations/3784.
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Managed care has revolutionized the healthcare industry. Prior to managed care, traditional insurance companies managed the healthcare industry. These insurance firms would monitor and authorize treatment to persons enrolled with the insurance company. Health Maintenance Organizations (HMOs) began to develop methods to provide similar service as the large insurance companies at a fraction of the cost. HMOs accomplished this by selling their products directly to employer groups. This significantly reduced administrative costs that had been traditionally passed on to the consumer. Unable to financially keep pace with the HMOs, the insurance companies abandoned the health insurance arena. As managed care has grown so have the problems associated with his system. Issues involving antitrust, confidentiality, privacy, and best practices are but a few of the critical issues facing managed care. All three branches of the United States government have been involved in resolving issues pertaining to managed care. Reforms have been demanded from the system and the current political climate may force the system to reconsider the manner in which it is conducting business. Minority consumers and specifically African Americans traditionally have been discriminated against from engaging in such life activities as housing, voting, commerce, and banking, without judicial intervention. The healthcare industry is no exception. The United States Surgeon General, in his seminal report on mental health, identifies that African Americans and other minorities have been excluded from obtaining appropriate and timely healthcare. The Surgeon General’s report coupled with the President’s report on Healthy People 2000, identify that initiatives are needed to rectify the inequities in healthcare in healthcare service delivery. A total of fifty-two African American consumers of mental health service with a primary diagnosis of adjustment disorder were surveyed to assess their perceptions as to whether or not they have access to their behavioral health services. The Consumer Access Questionnaire was designed to gather both demographic and consumer perceptions on the accessibility and feasibility of managed care for this selected population of African Americans. In all categories surveyed on the questionnaire, the results revealed that the respondents were able to access their outpatient behavioral health provider when utilizing the managed care system. The respondents provided an overall satisfaction rate with their respective managed care plans. 2
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Abdelrahim, Mahgoub. "Sudan social health insurance : challenges towards universal access to health care." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/sudan-social-health-insurance-challenges-towards-universalaccess-to-health-care(cd798918-f63f-4d3d-8019-2229c89ca3dc).html.
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To achieve effective access to health care, countries have adopted various policies to improve the populations' legitimate right to obtain health care when needed. Social health insurance has been proposed by the WHO as a means to securing sustainable access to health care particularly for developing countries. As one of the developing countries, Sudan launched SHI in 1994; however, population coverage still does not exceed 28.7% of the total population. Given the complexities of access to health care, the issue of achieving universal access by the adoption of SHI is faced with various challenges. Recognising the factors that influence an individual's decision to access health care ultimately adds to the success of the policy intervention to meet the stated goals. In addition, understanding and recognising the households' perspectives and motives to affiliate with SHI is critical to the success of the devised policy initiative. Therefore, this thesis examines the determinants of both access to health care and enrolment in social health insurance in Sudan. It also examines the implication of the adoption of social health insurance as a means to improving the population's access to health care. To achieve the stated objectives, the thesis adopted a quantitative cross-sectional study design involving a household survey in Kassala State in Sudan. The household survey (n=560) collected information from 280 voluntary insured households as well as 280 uninsured households living in rural and urban areas of Kassala State. The study confirms that both access to health care and voluntary enrolment in SHI in Sudan are influenced by factors embedded in the Andersen and Penchansky models of access to health care. These factors include the head of the household's; age, place of residence, gender, health status, the number of family members, perception about the waiting time to see the doctor, perception about the staff treatment, the level of knowledge about SHI and the monthly income. The study confirms that SHI does not act directly to improve utilization of health care; instead, its effect is mediated by other factors especially income level. Thus, access to health care is not merely the function of the health insurance status of the population; however, together with empowering the household's income level, improving the supply side of the health delivery system and reducing the gender inequality SHI is more likely to improve the population's access to health care. In addition, the study proves that those who are able to pay the health insurance premium and joined the scheme, are either looking for additional value for money (e.g. getting health services at a cheap price) or escaping an escalating cost of health care resulting from personal costly health status (e.g. chronic illness). Thus, the success of improving voluntary uptake of SHI depends on adding convincing value for money, raising the people's awareness about the scheme especially female households, targeting rural residence, especially those with large family size, and otherwise adopting a compulsory enrolment policy. The thesis contributed to knowledge through the development of a single theoretical framework encompassing both the health seeking behaviour and the adequacy of the health delivery system. The theoretical framework not only studied access to healthcare but also the factors that influence enrolment in health insurance. The new conceptual framework and the thesis's policy implications are applicable to developing countries that adopt SHI and express socioeconomic characteristic and problems resembling that of Sudan. It is also worth mentioning it is the first study to evaluate the impact of Sudan SHI in terms of population access to health care.
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DiMarco, Marguerite Ann. "Access/Utilization of Dental Care by Homeless Children." Case Western Reserve University School of Graduate Studies / OhioLINK, 2007. http://rave.ohiolink.edu/etdc/view?acc_num=case1184352136.
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Thompson, Jennifer W. "Insurance status, health care access, and adolescent smoking initiation." CONNECT TO ELECTRONIC THESIS, 2007. http://dspace.wrlc.org/handle/1961/4144.
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Lee, Jae Chul. "Health disparities in access to health care for older people with disabilities." Diss., Connect to online resource - MSU authorized users, 2008.
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Thesis (Ph.D.)--Michigan State University. Rehabilitation Counselor Education , 2008.Title from PDF t.p. (viewed on July 2, 2009) Includes bibliographical references (p. 128-144). Also issued in print.
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Eneh, Ann Ogorchukwu. "Access to Primary Care in Pennsylvanian Rural Townships." Thesis, Walden University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10787679.
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Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas’s model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using Edward and Welch’s extension of Colaizzi’s 7-step method for qualitative data analysis. Key findings included perceptions that (a) primary care access is limited in Mifflin County due to inadequate health services emanating from insufficient community health centers, provider shortages, health insurance issues; (b) high cost and poor choice of services discourage residents from seeking preventative care; (c) distance from services reduce residents’ ability to access primary care; (d) service problems impact the quality of care received, such as a lack of provider training in opiate addiction; and (e) providers and residents should be involved in primary care service planning since they can provide valuable information to help improve access to services. Positive social change could occur through improvement in access to primary care using a collaborative approach and community involvement, in policy formation and service planning.
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Du, Toit Elizabeth. "Access to care in people living with HIV." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/12351.
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Includes bibliographical references.South Africa has the most people living with HIV (PLWH) in the world. With increased access to HIV Counselling and Testing (HCT) as well as expanded Antiretroviral Therapy (ART) treatment guidelines; there is a large and increasing number of people who need access to HIV care. Limited data and few studies have evaluated access to HIV care. A cross sectional survey with stratified random sampling was conductedfrom January – April 2011 to determine the proportion of PLWH in urban areas in thegreater Cape Town area who are accessing appropriate HIV care and factors associatedwith accessing care. The sampling frame for this study was the Zambia South Africa TBand AIDS Reduction (ZAMSTAR) Study. Self reported HIV positive adults were randomly selected. Self reported HIV negative adults or adults of unknown HIV status were also randomly selected in order to decrease possible stigmatisation. Consenting participants were interviewed and completed a questionnaire detailing their access to HIV testing and care. Participants who disclosed that they were HIV positive were included in the analysis. Access to appropriate HIV care was defined as one of three scenarios: 1. Receiving ART and having attended an ART clinic or collected ART medication within the last three months. 2. Undergoing ART work up and having attended an ART clinic within the last three months. 3. In PreART care having had a CD4 count in the last 6 months. 1257 participants were interviewed. 627(50%) reported being HIV positive, 487(39%) HIV negative and 143(11%) did not know or wish to disclose their status. Of the 627 HIV positive participants: 392 (63%) reported taking ART of whom 369 (94%) accessed appropriate HIV care. 25 (4 %) were being worked up for ART of whom 16 (64%) accessed appropriate HIV care. 210 (33%) were in PreART care, 81 (39%) having accessed appropriate HIV care. Females were 3.78 times more likely to be in appropriate care than males (p <0.001), and a person in the age category greater than 45 years was 4.63 times more likely to be in appropriate care than someone in the age category 15-24 (p= 0.002).
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Whitener, Louise M. "Using Hongvivatana's model to evaluate health care access : a field study of adolescent women's access to reproductive health care services in rural Missouri counties /." free to MU campus, to others for purchase, 2000. http://wwwlib.umi.com/cr/mo/fullcit?p9974703.
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Goldsmith, Laurie J. Ricketts Thomas C. "Access to health care for disadvantaged individuals a qualitative inquiry /." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2007. http://dc.lib.unc.edu/u?/etd,973.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2007.Title from electronic title page (viewed Dec. 18, 2007). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Health Policy and Administration, School of Public Health." Discipline: Health Policy and Administration; Department/School: Public Health.
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Liu, Xiaohui, and 刘晓辉. "Change in access to health care in Guangzhou, 1990-2009." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B4517328X.
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Subar, Paul Elliott. "Access to oral health care for vulnerable populations in California." Scholarly Commons, 2009. https://scholarlycommons.pacific.edu/uop_etds/2393.
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The need for health in general and oral health in particular is a basic and fundamental element for a quality life. Not everyone in America has access to basic oral health services. California, in particular, has greater challenges than other areas of the country in providing basic oral health services to everyone. This paper will discuss the problems of accessing oral health care, the importance of achieving oral health care, the necessity of maintaining oral health, the factors influencing oral health care access, and the response of the dental profession to the problems of access to oral health care. These problems will be examined from the following three perspectives: (1) Statewide Perspective, (2) Locality Perspective, (3) Individual Perspective. Potential solutions for vulnerable populations in accessing oral health care will be developed using data from quantitative and qualitative methodologies.
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Yang, Feng-An. "Three Essays on Access to Health Care in Rural Areas." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu152353045188255.
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Gibson, P. Joseph. "Access to health care : Medicaid fee-for-service versus capitation /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/10882.
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Kuang, Xiaoxin, Kiana R. Johnson, Karen Schetzina, Claudia Kozinetz, and David L. Wood. "An Ecological Model of Health Care Access Disparities for Children." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5139.
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Ou, Christine Hui-Kuan. "Health behavior, primary care access, and unmet health needs in Chinese young adults." Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/36752.
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Background and Purpose: According to the Canadian Community Health Survey conducted in 2000-1, 12% of Canadians reported experiencing an unmet health need compared to four percent in 1994-5. There is growing reason to investigate the increasing number of Canadians reporting unmet health needs, particularly among young adults (between 18 and 30 years of age) who access health services less frequently than any other age group. In particular, the growing population of Chinese living in Canada present unanswered questions regarding the health needs of Chinese young adults. The purpose of this study was to examine: 1) if Chinese young adults who primarily speak Chinese experience more unmet health needs when compared to English-speaking Chinese young adults and, if there are, 2) the reasons why Chinese young adults have unmet health needs.
Methods: A mixed methods approach was taken; in-depth interviews (n=8) with Chinese young adults were used to complement and explain findings from a secondary analysis of a larger cross-sectional survey of the primary health care seeking behaviours of Chinese-, English-, and Punjabi-speaking Canadians.
Findings: Fifty-eight Chinese young adults participated in the primary health care survey; ten percent (n=6) reported having an unmet health need related to the availability and accessibility of health care. Language preference was not found to be associated with unmet health needs. Close to two out of three young adults reported seeing a physician in the past year. Twenty-four percent reported accessing health care outside of Canada. In-depth interviews revealed that Chinese young adults had unmet needs due to the lack of a primary care provider and not accessing preventive care. Acculturation and health behaviour was found to be more predictive of unmet health care needs than language.
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Wen, Siying, and 溫思穎. "Health insurance effects on health care access for rural residents in Guangzhou city." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46942749.
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Sims, Anita. "Deprivation and health : social inequality and equity of access to health care services." Thesis, Sheffield Hallam University, 2003. http://shura.shu.ac.uk/20366/.
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The major aims of this research were to investigate and analyse the connections between social deprivation, health inequality and equity of access to health care. Local and national case studies were used to illustrate inequity of access and to explore and assess policies and procedures that attempted to address such inequities at a local level. The available data sources, their limitations and scope were reviewed and described. In depth examinations and critical reviews were made of concepts and tools to measure deprivation and equity. A case study using the (then) new 1991 Census variable, limiting long term illness in a policy context together is described together with validation via a local survey in Shirebrook in North Derbyshire. The use of techniques for operationalising equity as extended to GP allocations is examined in some action research undertaken in North Derbyshire. Social class variations and their influence on place of death amongst cancer patients are examined, quantifying and describing apparent inequity in patterns of access to place of final care for cancer patients in both a local and national context. This work described, analysed and interpreted the connection between social class and access to hospice, home, and hospital deaths.
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Dunkley-Hickin, Catherine. "Effects of primary care reform in Quebec on access to primary health care services." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=123121.
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Primary health care reform has become an area of priority in health policy with a strong importance placed on interdisciplinary teams of health care professionals. Quebec's model, the groupes de médicine de famille (GMFs), were introduced late in 2002 emphasizing team-centered approaches to service delivery and aiming to improve access to primary health care, especially to improve after-hours access and to increase the number of Quebecers with a family doctor.A decade after their implementation, I investigated the impact of GMFs on various measures of access to primary health care and perceived remaining barriers. I emphasize potential access – i.e. measures that capture whether an individual has the ability to access needed health care including having a regular medical doctor.I used data from seven waves of the Canadian Community Health Survey to capture reported access to primary care and barriers to access. GMFs emerged at different rates in different health regions across Quebec allowing the construction of a GMF 'participation' measure using the share of primary care physicians practicing in GMFs in each health region and year. I employed a modified difference-in-difference analysis design that uses multivariate regression analysis to control for time trends in the outcomes, time-invariant differences between regions and individual-level covariates in an attempt to estimate the causal impact of GMF implementation on access to primary health care.I verified that pre-policy differences in terms of population and socioeconomic characteristics between regions with ultimately high vs. low rates of GMF participation are reasonable and remain fixed over time, making comparisons of these regions appropriate. Results suggest that rates of reported access have increased over time in most Quebec health regions. However, these measures of access vary across regions and some always report lower rates of access. Controlling for time trends, fixed differences between regions, and individual characteristics, reported access does not change significantly as GMF participation increases. Improved access to primary health care was one of the principal objectives of Quebec's primary care reform a decade ago. My findings suggest that increased GMF participation has not improved several important measures of access, and that additional policy measures may be necessary to increase potential access to primary health care.La réforme des soins de santé de première ligne occupe une place prioritaire parmi les réformes de santé, notamment avec une grande importance accordée à des équipes interdisciplinaires de professionnels de santé. Le modèle choisi par Québec, les groupes de médecine de famille (GMFs), a été mis en place à la fin de 2002. Ce modèle met l'emphase sur des équipes interprofessionnelles et vise à augmenter le nombre de Québécois avec un médecin de famille, ainsi qu'à offrir une plus grande accessibilité des services de la première ligne, notamment hors les heures normales de travail. Une décennie après leur implantation, j'ai étudié l'impact des GMFs sur diverses mesures d'accès aux soins de santé de première ligne. Je mets l'emphase sur l'accès potentiel – c'est-à-dire les mesures permettant de déterminer si un individu a la possibilité d'accéder aux soins de santé nécessaires, y compris d'avoir un médecin régulier.J'ai utilisé des données de sept cycles de l'Étude sur la santé dans les collectivités canadiennes pour capturer l'accès déclaré aux soins de première ligne et obstacles à cet accès. Il existe une variation régionale dans l'implantation des GMFs à travers les différentes régions sociosanitaires du Québec, ce qui me permet de construire une mesure de participation aux GMFs constituée de la proportion des médecins de première ligne pratiquant en GMF par région sociosanitaire et par année. J'ai employé une analyse qui consiste de modèles de différence-dans-les-différences modifiées qui utilise une analyse de régression multivariée pour contrôler les tendances temporelles, les différences constantes entre les régions, et les covariables au niveau individuel, le but étant d'estimer l'effet causal de la mise en œuvre des GMFs sur l'accès aux soins de santé de première ligne.J'ai vérifié que les différences de caractéristiques populationnelles et socio-économiques dans la période pré-politique entre les régions ayant un taux élevé par rapport à celles ayant un faible taux de participation aux GMFs sont raisonnables et fixes au cours des années de mon étude, rendant ainsi toute comparaison de ces régions appropriées. Les résultats suggèrent que les taux d'accès déclarés ont augmenté au fil du temps dans la plupart des régions sociosanitaires du Québec. Toutefois, ces mesures d'accès varient selon les régions et certains signalent toujours des taux inférieurs d'accès. Contrôlant pour les tendances temporelles, les différences fixes entre les régions, et les caractéristiques individuelles, l'accès déclaré ne change pas de manière significative avec l'augmentation de la participation aux GMFs.Un meilleur accès aux soins de santé de première ligne constituait l'un des principaux objectifs explicites de la réforme des soins de santé de première ligne de 2002. Mes résultats suggèrent que l'augmentation de la participation aux GMFs n'a pas amélioré plusieurs mesures importantes d'accès. En conséquence, des politiques supplémentaires pourraient être nécessaires pour accroître l'accès potentiel aux soins de santé de première ligne.
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Al, Magrabi Katibah Saad Aldean. "Geographical aspects of health and use of primary health care services in Jeddah, Saudi Arabia." Thesis, University of Strathclyde, 2001. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=21426.
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This thesis examines the contribution that geographical analysis can make to the study of the variation in the patterns of human health and subsequently to the discussion on the type and level of use of the public health service in a rapidly developing country. The current study was conducted in Jeddah Governorate, Kingdom of Saudi Arabia during the period 1994 and 2000. One of the main aims was to examine the pattern of health services provided in Saudi Arabia and this aim was achieved by investigating the provision and use of the Public Healthcare services. An attempt was made to clarify the complex web of relations that existed between, on the one hand, the different socioeconomic and geographic factors and on the other, the distribution of common ailments together with the level of utilization of health services. Shortcomings in the nature of the official health statistics regarding socioeconomic conditions of the patients were remedied through the use of a questionnaire. A tot al of 1000 patients from the eight PHCCs were surveyed for their use of the public health service. Data was collected from the same patients on their socio-economic, education and habitation details. This sample was used to supplement the data collected from the official government health statistics. These two data sets permitted an evaluation of the occurrence of different ailments and the variations in geographic distribution among the eight selected PHCCs. Difficulties persisted in the availability of official 1992 census data until publication of census data became available in 1999. In contrast to the problems of the census data, the availability of accurate and up-to-date patient records compiled by Ministry of Health staff was of considerable benefit to this research project. Use was made of Geographic Information Systems software for the analysis of data collected at the level of the PHCC. This allowed visual identification of the spatial variation in the use of the different health services and also allowed the identification of gaps in healthcare provision. The study showed that a density of habitation index used as a prime indicator of socio-economic status could be used as an indicator of the occurrence level for a number of common diseases. A pattern of disease was observed that suggested that the number of visits to PHCCs was substantially higher in low socio-economic districts compared to medium and higher socio-economic districts. It can be shown that the most common ailment was Upper Respiratory Tract Infections followed by Dental and Gingival diseases. Persons aged between 15 and 44 years made most visits to PHCCs although children under 15 years made proportionately greater use of PHCC facilities. No difference could be found between Saudi and Non Saudi as regards the occurrence of the most common ailments and diseases. The lack of difference was probably due to the close integration of the two population groups and the sharing of the same local environment. This similarity occurred despite considerable differences in income levels and socio-economic status. The level of utilisation of health centers in the selected districts showed differences, being higher in those districts categorized as low socio-economic in the south of Jeddah when compared to higher socio-economic districts in the north of the city. It was evident that the difference in socio-economic factors had an impact on the occurrence of some frequently occurring diseases e.g. URI, Dental, Ophthalmic, musculoskeletal and skin diseases. Although not primarily concerned with private health care facilities, for completeness sake some information was collected on the use of private health care in conjunction with public health care facilities. The author was surprised to discover that greatest use of private facilities occurred among women and children patients from Al Nuzla al Yamaneyyah and Al Thaalebah, districts that were characterised by low socio-economic conditions. The use of traditional folk healing was also briefly studied as this form of treatment remains important for some patients. Results showed that there was no difference between the educational standards of patients and their use of traditional folk healers. Again, children and women constituted the majority (86.6%) of users of traditonal healing with Saudi users (18.9%) higher than non Saudi (11.4%). There remains the supposition that alternative medicine may be of far greater importance than the sparse official data suggests. The unquantified illegal immigrant population may be totally reliant on unofficially operating alternative medicine centres. The thesis concludes by recommending a number of improvements to the existing public health care system. Some changes in the policy and practice of PHCC services will inevitably require more financial resources. These include an extension of the opening times of PHCCs and an increase in the number of specialist facilities such as dental surgeries. Other changes may not require more finances. These include a strengthening of communication and co-operation between PHCCs and hospitals to improve the referral of patients. Expansion of the existing computer network connecting PHCCs with hospitals should be given high priority.
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Borders, Stephen Boyce. "Transportation barriers to health care: assessing the Texas Medicaid program." Texas A&M University, 2003. http://hdl.handle.net/1969.1/6016.
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Transportation is frequently cited as a barrier to health care, but rarely have
researchers analyzed the problems in depth. The purpose of this study was to assess the role
transportation plays in the utilization of preventive health care services among Medicaid
recipients ages 0 - 20 in Texas. This preventive care is known as Early Periodic Screening
and Diagnostic Testing (EPSDT), a comprehensive prevention and treatment program for
Medicaid eligible children.
Our computer assisted telephone interviewing based survey was administered to
Medicaid recipients selected from a representative sample through a stratified sampling
scheme. Binary logistic regression models were used to assess and predict factors associated
with utilization of the Texas Medicaid Transportation Program (MTP) and utilization of
EPSDT. We also used k-means cluster analysis to identify subgroups of Medicaid clients with
particularly acute transportation barriers.
Of the 1,214 Medicaid recipients interviewed, the overall odds of a Medicaid recipient
being a MTP non-user was 0.94. For clients with automobile access, the probability increases
to 0.98. Clients who experienced difficulties paying for gasoline decreased the overall odds to 0.86. When examining utilization of EPSDT, the overall probability of being a low utilizer was
0.59. Two factors, Spanish-speaking patients (0.21) and clients with more than one child at
home (0.54) decreased the overall odds of being a low utilizer, while those with difficulty
paying for gasoline increased the odds of being a low utilizer to 0.63.
Increasing EPSDT utilization among the millions of Texas Medicaid recipients is an
important policy objective. Because the Texas Medicaid population is large and diverse, no
single approach to increasing utilization is likely to address all needs. The group concept
provides a means to understand which Medicaid recipients do not access MTP services and
those with low utilization rates. These groupings can be useful in targeting Medicaid clients
with specific transportation difficulties. Instead of broad informational campaigns, policy
makers should devise targeted strategies to promote the most appropriate types of assistance.
In addition to expanding transportation options, policy makers should also examine the
locations in which care is delivered, considering telemedicine, mobile health and school-based
health clinics as options.
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Kaylor, Mary. "Access to dental care for women of childbearingt age." The Ohio State University, 2007. http://rave.ohiolink.edu/etdc/view?acc_num=osu1190144125.
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Asthana, Manisha. "Delay in access of health care in California A project report." Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1527358.
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Delay of health care negatively impacts patient satisfaction and contributes to an inefficient healthcare system by increasing the use of the emergency room for non-urgent conditions. Policymakers argue that long waits will result in delays in diagnosis and treatment, and these delays negatively affect individual health.
California is a diverse state and comprises of people from various ethnic backgrounds. Consequently, there are cultural, linguistic and various other underlying reasons which contribute towards the delay in health care.
Apart from this, California has a wide range of people, which varies in socioeconomic status and there is a large segment which delays health care due to lack of health insurance. This study focuses on analyzing the reasons behind the delay in health care among California residents and proposes remedies which can help mitigate the problem.
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Fernández, Alexis Martínez. "Authorization schema for electronic health-care records : For Uganda." Thesis, KTH, Kommunikationssystem, CoS, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-101165.
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This master’s thesis project began at the Karolinska University Hospital. This thesis discusses how to design an authorization schema focused on ensuring each patient’s data privacy within a hospital information system. It begins with an overview of the current problem, followed by a review of related work. The overall project’s goal is to create and evaluate an authorization schema that can ensure each patient’s data confidentiality. Authorization has currently become a very important aspect in information systems, to the point of being a necessity when implementing a complete system for managing access control in certain complex environments. This requirement lead to the approach that this master thesis takes for effectively reasoning about authorization requests in situations where a great number of parameters could affect the access control assessment. This study is part of the ICT4MPOWER project developed in Sweden by both public and private organizations with the objective of improving health-care aid in Uganda through the use of information and communication technologies. More concretely, this work defines an authorization schema that can cope with the increasing needs of sophisticated access control methods where a complex environment exists and policies require certain flexibility.Detta examensarbete projektet startade vid Karolinska Universitetssjukhuset. Denna avhandling diskuterar hur man designar ett tillstånd schema fokuserat på att säkerställa varje patients dataskydd inom ett sjukhus informationssystem. Det börjar med en översikt över det aktuella problemet, följt av en genomgång av arbete. Projektets övergripande mål är att skapa och utvärdera ett tillstånd schema som kan garantera varje patient data sekretess. Bemyndigande har för närvarande blivit en mycket viktig aspekt i informationssystem, till den grad att vara nödvändigt att genomföra komplett system för hantering av åtkomstkontroll i vissa komplexa miljöer. Detta är i själva verket den strategi som detta examensarbete tar för att effektivt resonemang om en ansökan om godkännande i situationer där ett stort antal parametrar kan påverka i åtkomstkontroll bedömningen. Denna studie är en del av ICT4MPOWER projektet utvecklades i Sverige av både offentliga och privata organisationer i syfte att förbättra stödet sjukvård i Uganda med användning av informations-och kommunikationsteknik.<p> Mer konkret definierar detta arbete ett tillstånd schema som kan hantera de ökande behoven av sofistikerade metoder för åtkomstkontroll där en komplex miljö finns och politik kräver en viss flexibilitet.
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D'Ambruoso, Lucia. "Care in obstetric emergencies : quality of care, access to care and participation in health in rural Indonesia." Thesis, University of Aberdeen, 2011. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=165859.
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Study Setting: Two rural Indonesian districts served by the national midwife-in-the-village programme. Methods: Three critical incident audits of maternal mortality and severe morbidity: confidential enquiry, a verbal autopsy survey, and a participatory community-based review. Results: A range of inter-related factors contributed to poor quality and access. When delivery complications occurred, many women and families were un-informed, un-prepared, found care unavailable, unaffordable, and relied on traditional providers. Social health insurance was poorly promoted, inequitably distributed, complex, bureaucratic, and often led to lower quality care. Public midwives were scarce in remote areas and lacked incentives to provide care to the poor. Emergency transport was often unavailable and private transport incurred further expense. In facilities, there was reluctance to admit poor women, and ill-equipped, under-staffed wards for those accepted. Referrals between hospitals were also common. Examining adverse events from user and provider perspectives yielded multi-level causal explanations. These were used to develop a conceptual model relating structural arrangements (such as decentralisation, commodified care and reductions in public funding) to constrained service provision and adverse health consequences. Conclusions and recommendations: A policy shift towards healthcare as a public good may provide a route to reduce available maternal ill-health. Engaging with those who require and provide critical care in routine assessments can inform more robust health planning, and promote inclusion and participation in health.
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Magnussen, Gaute, and Stig Stavik. "Access Control in Heterogenous Health Care Systems : A comparison of Role Based Access Control Versus Decision Based Access Control." Thesis, Norwegian University of Science and Technology, Department of Computer and Information Science, 2006. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-9295.
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Role based access control (RBAC) is widely used in health care systems today. Some of the biggest systems in use at Norwegian hospitals utilizes role based integration. The basic concept of RBAC is that users are assigned to roles, permissions are assigned to roles and users acquire permissions by being members of roles. An alternative approach to the role based access distribution, is that information should be available only to those who are taking active part in a patients treatment. This approach is called decision based access control (DBAC). While some RBAC implementations grant access to a groups of people by ward, DBAC ensures that access to relevant parts of the patients medical record is given for treatment purposes regardless of which department the health care worker belongs to. Until now the granularity which the legal framework describes has been difficult to follow. The practical approach has been to grant access to entire wards or organizational units in which the patient currently resides. Due to the protection of personal privacy, it is not acceptable that any medical record is available to every clinician at all times. The most important reason to implement DBAC where RBAC exists today, is to get an access control model that is more dynamic. The users should have the access they need to perform their job at all times, but not more access than needed. With RBAC, practice has shown that it is very hard to make dynamic access rules when properties such as time and tasks of an employees work change. This study reveals that pretty much all security measures in the RBAC systems can be overridden by the use of emergency access features. These features are used extensively in everyday work at the hospitals, and thereby creates a security risk. At the same time conformance with the legal framework is not maintained. Two scenarios are simulated in a fictional RBAC and DBAC environment in this report. The results of the simulation show that a complete audit of the logs containing access right enhancements in the RBAC environment is unfeasible at a large hospital, and even checking a few percent of the entries is also a very large job. Changing from RBAC to DBAC would probably affect this situation to the better. Some economical advantages are also pointed out. If a change is made, a considerable amount of time that is used by health care workers to unblock access to information they need in their everyday work will be saved.
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Gagnon-Arpin, Isabelle. "Access to Health Care Services and Self-Perceived Health of Canada’s Official-Language Minorities." Thèse, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/20077.
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Official-language minorities in Canada may face specific issues in accessing health care services that can lead to negative consequences on their health, utilization of health care services and satisfaction with the health care system. A secondary data analysis of the 2006 Survey on the Vitality of Official-Language Minorities revealed significant differences between the Anglophone minority (n=5,161) and the Francophone minority (n=12,029) with regards to general health, and access to and use of health care services. Important predictors of these outcomes included age, education level, household income, marital status and place of residence (urban/rural). Access to health care services in the minority language was associated with self-perceived health in the Anglophone minority only. Health policy recommendations elaborated in light of the findings include working on both the supply and the demand of health care services offered in the two official languages, while taking into consideration important contextual differences between regions.
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Eneh, Ann. "Access to Primary Care in Pennsylvanian Rural Townships." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5075.
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Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas's model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using Edward and Welch's extension of Colaizzi's 7-step method for qualitative data analysis. Key findings included perceptions that (a) primary care access is limited in Mifflin County due to inadequate health services emanating from insufficient community health centers, provider shortages, health insurance issues; (b) high cost and poor choice of services discourage residents from seeking preventative care; (c) distance from services reduce residents' ability to access primary care; (d) service problems impact the quality of care received, such as a lack of provider training in opiate addiction; and (e) providers and residents should be involved in primary care service planning since they can provide valuable information to help improve access to services. Positive social change could occur through improvement in access to primary care using a collaborative approach and community involvement, in policy formation and service planning.
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Cenafils-Brutus, Doudelyne. "Perceived Barriers to Oral Health Care Access for Massachusetts' Underserved Parents." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2717.
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Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data were coded and analyzed for emerging themes, with the assistance of Nvivo software. The findings demonstrated that lack of time, the location of dental facilities, and the lack of sensitivity of dental providers were issues for parents in managing their children's oral health. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating the constraints faced by the underserved population in Massachusetts.
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Odeh, Michael. "Access to care in the State Children's Health Insurance Program (SCHIP)." CONNECT TO ELECTRONIC THESIS, 2006. http://hdl.handle.net/1961/3611.
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McQuillan, Carol Bridget Veronica. "Relationships between need and access to health care in Northern Ireland." Thesis, University of Ulster, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268610.
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Cowling, Thomas Edward. "Access to primary health care in England : policy, theory, and evidence." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/42497.
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Background: The U.K. Government plans to improve access to general practice services in England, partly by extending the opening hours of these services. The Government expects this to enhance patient experience and reduce use of emergency hospital services. The thesis aims to provide empirical evidence relevant to these policy expectations. Methods: Three observational studies of a cross-sectional questionnaire-based survey—the GP Patient Survey—from 2011-12 to 2013-14 (2,912,535 respondents aged ≥18 years old and registered to 8,289 general practices in England). Respondent-level data were deterministically linked at the practice level to Hospital Episode Statistics Accident and Emergency (A&E) and Inpatient data and to routine data on practice characteristics. Multivariable regression estimated associations between: (1) participation in the Extended Hours Access Scheme and patient experience; (2) several patient experience measures; and (3) patient experience and rates of A&E visits and emergency hospital admissions. Results: Most patients were very (40.0%) or fairly (42.3%) satisfied with the opening hours of their practices; results were similar for experience of making an appointment and overall experience. Practices that participated in the Extended Hours Access Scheme had greater adjusted mean values of these measures than non-participants, but the mean differences were small (≤1.25 on 0-100 scales). Overall experience was most strongly associated with doctor interpersonal quality of care (standardised coefficient=0.38; 95% CI: 0.38 to 0.38). A standard deviation increase in the practice-level mean experience of making an appointment predicted a 2.7% decrease (rate ratio=0.973; 95% CI: 0.966 to 0.979) in A&E visit rates and a 1.7% decrease (rate ratio=0.983; 95% CI: 0.978 to 0.988) in emergency admission rates. Conclusions: Changes to opening hours under existing policies are unlikely to improve patient experience of general practice substantially. Realistic short-term improvements in experience would likely have modest effects on use of emergency hospital services.
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Hollingsworth, Alex. "Essays on the Determinants and Implications of Access to Health Care." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/556668.
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An understanding of both the determinants of health care access and the implications of that access is of crucial importance because it enables us to learn about policies and institutions that are welfare enhancing in health outcomes. The first chapter of my dissertation explores how access to sanitaria aided in tuberculosis control in the time before antibiotics. Results indicate that access to an additional sanitaria bed reduced the death rate from tuberculosis for white residents by nearly .695 per 100,000 and had no impact for black residents. The next two chapters investigate the retail health clinic. First, I construct a choice model of clinic location that accounts for both demand and competition effects. I find that clinics are more likely to locate in areas that are populous, wealthy, educated, and white, and that they are less likely to locate in traditionally underserved communities. Second, I combine the results of my predictive model with data on ED visits to determine if clinics help direct patients away from receiving treatment at expensive emergency rooms. I find that access to retail clinics causes a substantial decrease in the number of ED visits for bronchitis and upper respiratory infections. The savings associated with retail clinic induced ED diversion is conservatively estimated to be at least $88 million in 2012 alone. In California, counterfactual analysis suggests that relaxing the barriers to clinic entry would result in $10.5 million in annual health care savings.
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Leaney, Zelda. "Health care for female sex workers : need, risk, access & provision." Thesis, University of Bath, 2006. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.428357.
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Sex workers are not only acted upon by medical, moral and legal discourses due to the risk they present to their own health but also due to the perceived risk they pose to the health of others. The diverse settings and different ways in which sex can be sold, combined with previous life experiences contribute to the wide variation in need and risk. This thesis investigates the differential understandings of need, risk, access to and provision of health care between sex workers and health care service providers. Simultaneously it offers an explanation for the continuation of need when health care provision exists. Four discursive themes directed the research: need, risk, access and provision. Data was obtained from semi-structured interviews with street and non-street sex workers and service providers. Discourse analysis was performed to ascertain the conditions, rules and authority under which statements in relation to the discursive themes are constructed. Thematic indexing enabled the analysis of the discursive themes within the empirical data, considering the inter-relationship with discursive constructs (i.e. stigma, safety, pollution, rights and power) identified within previous moral, medical and legal discourse. Sex workers and service providers identified need and risk as problematic drug use, damaged mental health, STIs and violence, but categorise and prioritise differently. Complex constructions were identified, suggesting underlying influences that direct them. Contradictions and tensions exist within the differential construction of the discursive themes, made more problematic by the chaotic lifestyle of many sex workers. The differential understandings must be recognised or the sex worker will continue to be 'maintained' within the complex and interlinked relationships of prostitution, damaged mental health and problematic drug use, the latter two made worse by prostitution but not solely a result of prostituting.
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Kelly, Melinda R. "Factors Affecting Health Care Access and Utilization Among U.S. Migrant Farmworkers." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6592.
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There are over 3 million seasonal and migrant farmworkers in the U.S. agricultural industry with a significant percentage of farmworkers documented or native to the United States. Migrant farmworkers live below the federal poverty levels at high rates and experience low health care access and utilization. Guided by the fundamental cause theory, the purpose of this phenomenological study was to examine the lived experiences of migrant farmworkers and identify the factors impacting their health care access and utilization. Face-to-face interviews were conducted with 12 migrant farmworkers who had worked in Southwest Texas agricultural stream. Data were analyzed and coded to identify themes. Findings indicated that although lack of health insurance was a decisive factor in whether migrant farmworkers accessed or utilized health care services, distance to services, inflexible working hours, and cultural factors related to seeking care also influenced participants' lack of access to and utilization of health care services. Results may be used to aid local, state, and federal agencies in assisting migrant farmworkers in bridging the gap in health care and obtaining needed services.
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Leung, Wai-Ching. "Equity of access to health care : case studies in primary care and coronary artery surgery." Thesis, University of East Anglia, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249587.
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Equity of access to health care was the founding aim of the NHS and a recent White Paper on NHS reforms re-emphasised its importance. This thesis consists of two contrasting studies on equity of access using individual patients as units of analysis. The main objective of the first study was to examine the equity of access to primary care services including GP consultation, out-of-hour services and referral to specialist services. The study involved secondary analysis of patient questionnaire data from a national survey. The objectives of the second study were to examine the equity of access to coronary artery surgery in one health district among those who underwent coronary angiography, and to examine whether the waiting time for coronary artery surgery was correlated with clinical need. It involved retrospective collection of data from medical records using the New Zealand Priority scores as an indicator of need. The first study showed that the following patient groups subjectively experienced disadvantages in several aspects of primary care services:- younger people, those with poor subjective physical and mental health, females, non-whites, residents in Inner London and those in paid work or full-time education. The possible reasons for these findings were discussed. It was recommended that the delivery of primary care services should take into account these results and that further research should be conducted into the extent and nature of differential patient expectation amongst different patient groups. The second study did not show any significant inequity of access to coronary artery surgery according to sex, age, smoking status and socio-economic status. However, there was little correlation between clinical need and waiting time for coronary artery surgery. These results informed subsequent development of cardiology and cardiac surgery services in the health district. The methodologies used in these two studies were compared and contrasted.
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Chauhan, Umesh. "Improving access to health care for minority ethnic populations with diabetes and heart disease." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.490119.
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Background: In the United Kingdom ethnic minority groups from the Indian sub-continent (India, Pakistan and Bangladesh) are at increased risk of diabetes and coronary heart disease. Variation in outcome these diseases in minority ethnic populations are related to inequity due, in part, to inadequate identification and treatment of underlying risk factors such as obesity but also in access to appropriate health care. Aims objectives: This thesis explores three possible contributing factors to these variations in health experience. Firstly, data from the Health Survey for England (HSE) is used to assess whether using waist circumference (WC) rather than body mass index (BMI) among patients of Indian subcontinent (South Asian) origin would improve risk prediction (related to obesity) for diabetes and hence increase the opportunity to detect those at risk. Secondly, a quantitative study using data from an electronic centralised cardiac rehabilitation register in the north west of England explores the variation in recording of cardiovascular disease risk factors and other clinical data in relation to ethnicity. Thirdly, a qualitative study explores the experiences and needs of South Asian patients following an acute cardiac event. Methods: Study 1: Subjects from the HSE 1999 were selected for analysis based on ethnicity. Logistic regression analysis was carried out to see how effective WC to an established risk score would be at identifying the South Asians with undiagnosed diabetes or impaired glucose regulation. Study 2: A shared central electronic database was developed for recording patient demographics and clinical information for all patients assessed for CR in East Lancashire. Analysis of the recording of clinical data was undertaken by ethnicity, gender and age. Study 3: Twenty participants (12 Pakistani, 6 and 2 Bangladeshi) eligible for CR were interviewed using a semi-structured format. Results: Inclusion of WC resulted a greater sensitivity (72%) and specificity (69%) increasing from 69% and 64% respectively with improved overall level of prediction for the identification of patients at risk of diabetes at the optimal cut point. WC was less likely to be recorded than BM! ( 2.5% versus 57.1 %). WC and BMl were both significantly less likely to have been recorded for women than for men (We: 20.7% vs. 28.7%; BMI: 57.0% vs. 68.2%) and for South Asian populations than for White populations (We: 18.7% vs. 26.7%; BMI: 55.0% vs. 65.3%). Patients in the study had a poor understanding of their disease and underlying risk factors with significant misconceptions. The importance of interventions by professional friends and family members (a doctor or nurse for example) was a recurrent theme in determining appropriate access to care. Reasons for non-attendance included those related to service provision (flexibility, setting, timing of classes and paternalistic attitude in relation to communication) and patient factors (language barrier, transport, health and religious beliefs). Conclusion: It was possible to include 'ethnic' specific WC cut-off points for use with the Cambridge risk score identifying individuals with diabetes among South Asian populations. CR database revealed inequity in recording of risk factors such as We. The qualitative study confirmed the inequity in both access and experience of CR services for South Asian patients. The barriers which restrict or diminish access to chronic disease health care such as CR services for the South Asian population are complex and related to not only to patient factors but also to system/provider levels and institutional factors, and the interactions between them.
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Chase, Ashley A. "Having your Cake and Eating it Too: Disparities in Access to Health Care within the United States." Miami University Honors Theses / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=muhonors1209134839.
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Taveras, Michelle P. "Access to Health Care and Patient Safety: A Model for Measurement and Analysis." Scholarly Repository, 2011. http://scholarlyrepository.miami.edu/oa_dissertations/697.
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The purpose of this dissertation is to effectively understand, measure, and model the impact of Access to Care (AC) on Patient Safety (PS) through the creation of a model that evaluates their interdependence. Through the use of statistical tools and through the combination of variables that define patient access to health care and patient safety, a Patient Access and Safety (PACSA) index is developed. The calculated Patient Access and Safety index provides information to both providers and patients about the impact of access and safety on treatment outcomes. The input variables used to support this research are Patient Access Factors (PAF) (Age, Insurance Type, Visit Type, List Price, and Days To an Appointment) and Patient Safety Factors (PSF) (Severity of Diagnosis, Race, and Gender). In this model, 7,535 observations were used from a single organization based in South Florida, in order to develop the index. The PACSA index offers a tool that helps providers, healthcare staff and patients evaluate patient safety as it is impacted by access to healthcare through the calculated index. This index produces an equation that examines the relationship between access to care and patient safety using the following relationship: PACSA=∑_(i=0)〖(.645〖PSF〗_i- .645〖PAF〗_i )+0.399〗An extensive literature review identifies the connection between AC and PS and the relationships governing these two concepts. Although large organizations like the World Health Organization (WHO), Agency for Healthcare Research and Quality (AHRQ), and Institute of Healthcare Improvement (IHI) have studied these concepts independently, there has not been a study that used a factor or index to describe the relationship. As the healthcare delivery system becomes more complex, and consumers demand better treatment outcomes, there is a growing need to analyze these concepts jointly. This study focuses on diabetic retinopathy (DR). This is a condition experienced by chronic Diabetic patients, and it is one of the major causes of blindness (National Eye Institute, 2009). The increase in the occurrence of Diabetes worldwide has heightened the disease and inspired clinical research. In 2002, it was estimated that the disease stemming from Diabetes, namely DR, accounted for about 5% of world blindness, representing almost 5 million blind people. If left untreated or undetected, about 2% of people become blind, and about 10% develop severe visual impairment. By the year 2030, a possible 36 million people will have acute visual impairments and 7.2 million people will possibly be blind worldwide. In the United States, there are 18 million people with Diabetes, and 30% have Diabetic Retinopathy (5.3 million Americans over the age of 18) (ATA Report 2004; AHRQ, 2004; WHO, 2004). Although this study focused on DR, the model has been designed with the ability to be applied to other diseases and conditions. The goal of creating the PACSA index is to help healthcare workers understand when to schedule patients within the context of access and safety. Current appointment schedules, which are the tools used by healthcare workers, use a “New patient vs. Follow up patient” design. The PACSA challenges the current scheduling schema. No longer will patients be categorized into “New vs. Follow Up” visits. Instead, they will be evaluated for access to care requirements and patient safety needs from the initial point of entry into the health system. The recommendation is to start designing schedules based on PACSA (low PACSA, medium PACSA, and high PACSA). In this new paradigm, the low PACSA would describe patients that have low disease complexity, low number of risk factors, and can wait a little longer for their appointment without having complications of disease from lack of treatment. On the contrary, the high PACSA would include a subset of patients that have high disease complexity, high number of risk factors, and require immediate appointment and medical continuity of care to have the best treatments and outcomes. The PACSA index can serve as a visual guide for decisions regarding access and patient safety requirements. Two key components of quality within healthcare include access to care and patient safety. To create “congruent system integration” (Maier-Speredelozzi, 2007), there must exist synchronization of all healthcare delivery operations. The Patient Access and Safety Index (PACSA) provides a framework for integrating these two components. This research and the indices developed can offer benefits to health care organizations, patients, physicians, and government entities by providing a versatile tool to help improve access to health care and patient safety.